Treatment includes digoxin-specific antibody fragments and supportive care. Lidocaine and phenytoin can be used for cardiac dysrhythmias when antibody fragments are unavailable.

There are no long-term complications of poisoning in patients treated appropriately for chronic digoxin toxicity, as long as anoxic brain injury, myocardial infarction, or terminal dysrhythmias have not occurred prior to treatment.

Definition

Digoxin is the most commonly prescribed cardioactive corticosteroid in the US. Cardioactive corticosteroids have been used for over 200 years in the treatment of dropsy, which is better understood today as oedema from CHF.
[1]Withering W. An account of the foxglove, and some of its medical uses: with practical remarks on dropsy and other diseases. Birmingham: Swinney for Robinson; 1785.
In therapeutic doses, they increase cardiac contractility and control the heart rate. Digoxin toxicity is a clinical diagnosis that relies in part on ECG findings such as signs of increased automaticity and AV node blockade (PVCs, slowed ventricular response). Serum digoxin concentration (SDC) is usually greater than the therapeutic range of 0.6 to 1.2 nanomol/L (0.5 to 0.9 nanograms/mL), but may not be elevated. In addition to pharmaceuticals, toxicity can also occur from exposure to a number of plants and animals that contain cardioactive corticosteroids, including dogbane, foxglove, lily of the valley, oleander, yellow oleander, red quill, and the
Bufo
species toad. Although these other toxins are clinically similar, this monograph specifically discusses only toxicity from digoxin.

Disclosures

Dr Scott Phillips would like to gratefully acknowledge Dr Oladapo A. Odujube and Dr Robert S. Hoffman, previous contributors to this monograph. OAO and RSH declare that they have no competing interests.